Endorphin Conspiracy, The (2 page)

Chapter 2

“Well, Dr. Davis, nice of you to pay us a visit. Four minutes to answer a page—you better cut that in half. Dr. Spiros has been setting his stopwatch again.

“Don’t forget, it’s July first.” Jan Creighton, head nurse on day shift, spoke with more than a hint of sarcasm

“Jan, you look great. New hairdo?” Geoff asked.

“Twenty-five pounds off, five more to go and counting. Oh, you mean the perm? You’re the first guy around here to notice.”

In truth, Geoff didn’t care much for Jan Creighton, though he respected the way she ran the ER. Forty-five, never married, sarcasm was her trademark.

“Where’s the action?”

“Trauma room one. Want me to take you there, or do you remember the way?”

Her words grated. “Good to see you, Jan. I’m sure I’ll be seeing you again real soon.”

From the strategic viewpoint of the nursing station, a central, Plexiglas-enclosed area about twenty by fifteen feet in dimension, Geoff could see all areas of significance, from the ambulance entrance to the trauma rooms. The nursing station functioned as traffic control, flow directed by the head nurse, visibility providing her the ability to monitor all ER activity and assign treatment rooms and staff as indicated by patients’ apparent conditions.

Geoff left the nursing station, Karen Choy in tow. He turned, collided with a passing medic, knocking him into one of the portable crash carts that dotted the hallway adjacent to the nursing station. Like a quarterback sacked from the blind-side, the medic sent his clip-board flying and crashed helplessly to the floor.

“Sorry, I didn’t see you coming.” Geoff was physically unscathed but embarrassed.

“Hey, man, where the fuck you brains at!” the medic said as he got up off the floor. He reclaimed his clipboard and brushed his behind.

When the medic looked up, Geoff instantly realized who he was, embarrassment giving way to pleasure. “Santos, you son-of-a-bitch! I couldn’t have knocked you on your butt better if I’d tried!”

“
Ay, Dios mio!
Geoffrey Davis, I thought you had died and gone to heaven without me. The laboratory is no place for a fine doctor such as yourself.”

“I’m back.”

The two men embraced warmly. Geoff turned towards Karen Choy, who stood by, obviously unsure what to make of it all. “Dr. Karen Choy, this is Enrique Santos, the best damn medic in the City of New York.”

Santos blushed, extended his hand. “Don’t believe anything he tells you, Dr. Choy, but it is a pleasure to meet you. You’ve got a fine teacher.”

“The pleasure is mine. I’ve heard a lot about you from the other residents.” Karen looked at Geoff. “Why don’t I meet you over by the trauma room?”

“Sure. I’ll be right over.”

They couldn’t have been from more different worlds: Geoffrey Davis, blueblood son of a surgeon from Connecticut, and Enrique Santos, blue collar, Puerto Rican medic from Spanish Harlem. Thirty-eight years old, of medium height with broad, dark features and a trim mustache, white shirt with its short sleeves rolled up above bulky biceps, the shirt’s top buttons left open far enough to expose a large, silver crucifix resting comfortably between well defined pectorals, Santos appeared the prototypical macho Latino. It was a well-honed facade, a means of protecting his sensitive, caring nature. Street smart and self-made, Santos was a living example that growing up in Spanish Harlem did not inevitably lead to a broken life.

If only his younger brother, Jose, had allowed Santos into his life, Geoff knew Santos could have gotten him off the streets and made him a productive member of society. But the lure of a street gang seduced him, stole him away. Higher than a kite one night on angel dust, he ended up in the NYTC ER, a victim of a hit and run. A younger Geoffrey Davis, the trauma doc then, spent a good part of the night with Jose, desperately trying to save his life. The bond between the doctor from Connecticut and the medic from Spanish Harlem was forged by sharing that personal tragedy.

“How’s everything going?” Santos asked, his warm, brown eyes searching Geoff’s.

“About as well as it can around this place.”

Santos slapped him playfully on the cheek. “
Bueno, bueno, mi amigo
. Hey, we’ll have you over for dinner real soon. Gloria will fill you up so good we’ll have to wheel you home in a barrel.”

“I’d love to. Maybe one day next week. You just getting off shift?”

“Yeah, long night. You see that cop Ceravola and I brought in—Smithers?”

Geoff looked toward trauma room one. “I was just on my way there.”

“He’s in bad shape. Looks like he was attacked by a pack of wild dogs. Good luck.”

An overhead page pierced the air. “Dr. Davis, trauma room one, stat!”

Geoff glanced back toward the trauma room. “I’d better get going. Good to see you, Santos. I’m sure we’ll be seeing a lot of each other this year.”

“
Hasta luego,
Geoffrey.”

Geoff bolted to the trauma room area, met Karen. Trauma room one contained four beds, each separated from the others by curtains suspended from the ceiling. A young black man, in the far bed, diagonally across the room, obviously quite intoxicated, was tied to the bed by four leather restraints and was being tended by an intern, who was grappling to suture his face back together while at the same time dodging the patient’s attempts to bite his hand.

“Makes you feel appreciated, doesn’t it?” Geoff said, pointing to the struggling intern at the far bed. As he neared the room, it became obvious where the real action was. Just beyond bed one stood four New York transit cops, one with sergeant’s stripes.

Geoff knew right away the patient was a cop. Stat calls took on a heightened level of urgency when a cop was involved. Dr. Spiros made sure all residents understood this from day one in his ER.

An organized tumult of activity buzzed around bed one—blood spurting into color-coded test tubes, IV’s dripping frantically to keep up with blood loss, stethoscopes and lights probing for answers. Medicine in the trenches. An army of doctors, nurses and technicians in their green scrubs, each with a task, all coordinated by the trauma doc, a second year surgery resident who acted as field commander, barking out orders, triaging when necessary.

“Get a blood gas, stat,” called out the trauma doc, Dave Flynn. He turned to Lynn Graves, the nurse. “How are his vitals doing?”

“Pulse one-forty and thready. BP holding at ninety over fifty.”

“Run those IV’s wide open, or we’re gonna’ be starting a dopamine drip real quick. Type and cross him for five units whole blood, stat!” Flynn ordered.

“They’re running full bore now.”

“Is the blood gas drawn yet?”

“It’s already gone to the lab,” said an intern.

Lynn Graves glanced at Geoff and Karen approaching the bedside. “There’s no place like home, is there Dr. Davis?”

“There’s definitely no place like this home, Lynn. I missed the ER.” Geoff smiled at Lynn, then turned to Dave. “Need some help?”

“I’d love some, Geoff. You know how it is on July 1.” He looked at Karen. “Too many rookies on the trauma team.”

“What’s the story here, Dave?” asked Geoff.

“Forty-two-year-old transit cop attacked while on duty this morning. Here at the 168th Street subway station, in the elevator, going down to the IRT. Fucking animals out there. He’s been in and out of consciousness. Bad head injuries, as you can see, may have a basal skull fracture. Hard to believe this was done by one fucking lunatic,” said Flynn, shaking his head from side to side.

“Did you do a peritoneal lavage? Any internal bleeding?” Karen asked.

“Do you think we’ve been sitting around playing Xbox, Dr. Choy?”

“Cool down, Dave. Karen’s question was a good one,” said Geoff.

“Sorry. It’s been a long night.” Flynn’s hand massaged his brow. “We did a lavage. Fluid was bloody. He’s probably got a lacerated liver or spleen. We’re waiting for the general surgeons to evaluate that. Best we can do here is keep up with the blood loss.”

Flynn was a good man, but obviously under a lot of pressure already today. A cop on his first day in the trauma unit. A lot for anyone to handle. Still, he was doing what he had to do. Geoff stepped back and let him work.

Geoff remembered his own days in the ER all too well. Call nights eternal, living in a time warp. The world went on outside the glass cage—people laughing, playing, loving—but for the resident on call in the ER, the world was a constant barrage of the downtrodden and abused—heads slashed, bashed and blasted away, limbs busted and dangling, faces contorted in anguish. Stealing life back from the brink of death, a day’s work in the ER. Days with little sleep, few breaks, irregular meals. Geoff loved the adrenalin, the camaraderie.

What he hadn’t liked was the toll it had taken on his marriage. Sarah had been his lifeline to humanity, had forced him to remember his priorities daily. A part of him seemed to have died with her.

“Better get a central line in right away,” Geoff said. “You’re going to need it to keep up with his fluid—”

“Pulse 150, BP’s down to 70/palp.”

The cardiac monitor alarm sounded. “He’s in V-fib! One milligram of epi,stat!”

Flat line. Nothing. Geoff grabbed the paddles out of the intern’s hands, placed them on the cop’s chest. “Set it at two hundred. Stand back, everybody clear?”

“Two hundred,” Lynn said.

“Clear!” Geoff pressed the button. The patient’s torso arched in the air and flopped back down on the bed board with a thud. The monitor did not change.

“Continue chest compressions!” said Flynn.

Still no pulse.

“Charge it again!” ordered Geoff.

“Ready.”

“Hold on,” said Geoff. The silence was broken by rhythmic beeping. Smiles broke out all around.

“Pulse 110, BP 95/60.”

“Looks like he’s stabilizing for now,” said Flynn.

From the corner of the curtained area, Dr. George Spiros quietly observed the frenetic scene. His belt weighed down by three pagers and two cell phones marked his rank as commander-in-chief. He was a short man with graying black hair, stocky build with a soft middle. Spiros watched every move keenly, his small but intense, dark brown eyes peering through thick lenses set in tortoise-shell frames, his expression severe as he waited for someone to make an error in judgment.

Think clearly, but act quickly and instinctively
, he constantly told his residents. He drilled this into their minds every morning during five a.m. rounds, when he reviewed aloud every single case from the night before, red grease pencil in hand. No one escaped criticism; no case was handled well enough. There was no place for error in judgment in his emergency room, no place for hubris—except his. Fear and respect motivated the residents passing through his ER. It worked remarkably well.

A nurses aid entered the room, bags in hand. “Blood’s arrived.”

“Hang two units and run them in full bore,” said Flynn. He turned to Geoff. “Thanks for the help. You don’t have much time to do your neuro evaluation. The OR will be ready for him in ten minutes.”

“No problem. Dr. Choy and I will take it from here. Why don’t you take a break.” Geoff motioned Karen to approach the head of the bed, while nurses and interns continued about their work.

The victim was fair-skinned, somewhat overweight. His face was swollen to marshmallow puffiness, the white flesh of his cheeks and forehead marked by deep crimson lacerations, as if something had attempted to gouge out his eyes. Sanguineous fluid oozed from his nose and right ear. Dark bruises encircled both eyes, giving him a raccoon-like appearance. Around his neck was a stabilizing neck brace to protect his upper spinal cord from excessive movement. Possible spinal fracture. His blue uniform had been cut away, revealing numerous, large bruises, abrasions, and bite marks on his chest and arms. Were this an ER in Montana, he could have been the victim of a grizzly bear attack. But this was New York, where transit cops patrolled the dusky, fetid bowels of the subways, often in perilous isolation, where the animals were most frequently two-legged.

Penlights and reflex hammers in hand, Geoff and his apprentice evaluated their patient.

“The bloody fluid coming from his nose and ears, that’s spinal fluid, isn’t it?” asked Karen.

“Sure looks like it. That, along with the raccoon’s eyes pretty much point to a basal skull fracture. We’ll know when he has his MRI scan. He must have been smashed on the back of the head with a hard object or fallen down, hitting his occiput. He’s in a bad way.”

“He seems to be losing the little bit of consciousness he had.” Karen checked his pupillary responses.

“What would you say his coma scale rating is?” Geoff asked.

“Moderate to severe head injury. Fair to poor prognosis.”

“Very good. Of course that’s all meaningless in the face of what his PET scan will show us regarding the actual extent of his brain injury.”

“Thorough evaluation, doctors,” interrupted Dr. Spiros, restless with his role of observer. “Now would you like to let me in on his neuro status is and your treatment plan? I don’t think I can put off the mayor, the police commissioner, and the press much longer.”